Making Market Transformation a Reality

By Janet Howard, DIRECTOR, FACILITY ENGAGEMENT, PRACTICE GREENHEALTH, AND Director, Content and Outreach, Healthier Hospitals Initiative on January 14, 2015

Join health care systems nationwide to demand healthier food and safer chemicals for your patients, families, visitors and staff.


I remember the feel of the fabric—synthetic and shimmery—not natural. At that time, many children’s pajamas contained a flame retardant chemical (chlorinated tris) that made the products feel funny, but was later banned because it can cause cancer. A parent buying pajamas makes it personal. It’s easy to connect with how closely we scrutinize what’s best for our loved ones.

That same scrutiny is needed when purchasing products in a healing environment, but sometimes chemicals, excessive packaging or wastefulness of a product are not part of the conversation (in fact, did you know that the same chemical used in those baby pajamas is still used in some furnishings?). In health care supply procurement, informed decisions require education and an understanding of the details of the products, services and equipment, balancing safety, quality, cost and health. This is environmentally preferable purchasing (EPP), and it’s spearheaded by Beth Eckl, director of EPP at Practice Greenhealth.

When health systems join together, pooling their substantial purchasing power to seek safer solutions, that’s a game changer and that’s what starts the conversation.

Every day, the lens of health can be used to make informed purchasing decisions. But it takes practice and time to identify priority areas. And it requires letting group purchasing organizations (GPOs) and the marketplace know the demand. When health systems join together, pooling their substantial purchasing power to seek safer solutions, that’s a game changer and that’s what starts the conversation. And lessons can be learned on all sides.

In 2014, Healthier Hospitals Initiative’s (HHI) Steering Committee members ( joined forces with Health Care Without Harm’s (HCWH) internal campaign expertise to send a clear message to the marketplace focused on two market transformation initiatives: antibiotics and meat procurement and safer chemicals in furniture. The science is strong to back up the need for change in these two areas.

Antibiotics and Meat 

Spearheaded by Lucia Sayre, Hillary Bisnett and their team in HCWH’s Healthy Food in Health Care workgroup, the Food Procurement Collaborative has been meeting with representatives from key supply chain stakeholders: food service management companies, GPOs, food distributors and hospital systems including Kaiser Permanente, Dignity Health, Fletcher Allen, University of California at San Francisco (UCSF), Advocate Health Care, Inova Health System, Partners HealthCare and Gundersen Health System. These stakeholders have identified challenges in sourcing, purchasing and tracking sustainable food products and are working on solutions that increase the transparency and effectiveness of the supply chain.

An important first step was to focus on one product category—the procurement of muscle meat (beef, pork and chicken) produced without the use of nontherapeutic antibiotics. Also key is the engagement of the educational sector. We partnered with Real Food Challenge, which works with university and college food services and School Food FOCUS, which works with K-12 public schools, launching a cross-sector “EdMed” collaborative effort influencing institutional procurement processes across the country.

HCWH also has a major campaign effort gaining momentum in the clinical community. Understandably, clinicians readily identify with this issue, as they are on the front lines dealing with the rapid increase in antibiotic-resistant bacterial infections in human medicine. Engaging clinical leaders as advocates is an important part of the strategy. When institutional food procurement is recognized as an activity that contributes to the overall health of our food system and our collective public health, every stakeholder in the supply chain will realize their responsibility to do the right thing. That’s when we will see important, large-scale change.

We’re off and running. A number of hospitals, medical centers and professional associations, including UCSF Medical Center’s Academic Senate, have passed resolutions to phase out the procurement of meat produced with nontherapeutic antibiotics. HCWH will continue to work with the approximately 377 hospitals that have signed onto the HHI Healthier Food Challenge to do the same.

Why Healthier Meat?

  • Approximately 23,000 Americans die from antibiotic-resistant infections each year, and the health care costs associated with these infections in the U.S. is $20 billion a year, according to the Centers for Disease Control and Prevention.
  • More than 300 organizations, including the American Medical Association and American Public Health Association, have advocated ending the nontherapeutic use of medically important antibiotics as feed additives.

Why Safer Chemicals?

  • Halogenated flame retardants1 are found in patient mattresses, cubicle curtains, window blinds, drapery, electronic equipment, computers, copy machines, refrigerators and microwaves.
  • Flame retardants can persist in the environment and build up in the food chain. They have been found in human and wildlife tissue, dust, sewage sludge, air, soil and water samples—even in the Arctic. Their health effects include reproductive, neurocognitive and immune system impacts.


See Health Care Without Harm’s 2005 publication, “Brominated Flame Retardants–Rising Levels of Concern”

Safer Chemicals

More than 250 hospitals have signed up for the Safer Chemicals Challenge, with a smaller number engaged in the healthy interiors goal. The first hospital to meet the healthy interiors goal—25 percent of a renovation’s spend successfully avoiding the HHI-identified chemicals of concern—was Beaumont Health System in Michigan.

As shared in a case study this year (, Beaumont Health System determined that by focusing on its biggest furniture spend—the task chair—it could work with its furniture manufacturer and identify a chair that met the goal. This win created a space for Beaumont to look at further opportunities for furniture, fabrics and finishes.

At CleanMed 2014 in Cleveland, Kaiser Permanente committed publicly to phasing out flame retardants from upholstered furniture systemwide. Four large health systems followed with a similar announcement: Beaumont Health System, Hackensack University Medical Center, Advocate Health Care and University Hospitals, which represent 7,000 patient beds throughout Illinois, Michigan, New Jersey and Ohio. Combined with Kaiser Permanente, the five health systems spend nearly $50 million a year on furniture.

A September 2014 meeting at Merchandise Mart in Chicago led by Rachel Gibson and Tracey Easthope of the HCWH Safer Chemicals workgroup showcased furniture manufacturers’ offerings with systems such as Kaiser Permanente, Advocate Health Care, University Hospitals Health System and others. As a result of this meeting, leading product manufacturers generated lists of furniture that meet the healthy interiors goal. These lists can be found on the HHI website (, login required).

In 2015, as HHI completes its three-year launch, it will transition into a permanent program of Practice Greenhealth. The Market Transformation Group’s work will continue to be a valuable benefit of Practice Greenhealth membership and will be led through HHI. “These are important public health issues that can no longer be overlooked,” said Practice Greenhealth Executive Director Jeffrey Brown. “One item at a time, we will continue the conversation and continue delivering the message that we must move toward better health through environmentally preferable purchasing.”