Metrics Matter

By Carolyn Kimmel on July 16, 2015

The latest releases of the Sustainability Benchmark Report and the Milestone Report help hospitals nationwide establish the metrics that they should meet to go shoulder to shoulder with other leading systems. 


Count that as one lesson learned at Palomar Health when it rolled out healthier food options as part of its sustainability initiative.

“We have had positive and negative responses to our efforts along the way, but as we have been able to stay the course through ups and downs and leadership changes, we are now seeing much more positive response to these fresher, healthier options,” said Barbara Hamilton, sustainability manager at Palomar, an 800-bed, three-hospital health system in north San Diego County, California.

In fact, these days some of the staff at Pomerado Hospital, one of Palomar’s system hospitals, complains when quinoa is not on the tray line in the café, Hamilton said.

Palomar Health, a member of Practice Greenhealth, was new to sustainability when it signed on to a 19-member coalition committed to implementing the Healthier Food Challenge, part of the larger Healthier Hospitals Initiative.

Today, by contrast, Hamilton said, “Our healthy food programs are becoming integrated into how we do business at Palomar Health.”

Testimonials like that are what energize staffers at Practice Greenhealth as they analyze hundreds of sets of data from their member hospitals and other hospitals wading into the waters of health care sustainability.

“There is increased awareness around environmental stewardship as a public health issueand we are seeing that,” said Janet Howard, director of member engagement and Healthier Hospitals for Practice Greenhealth. “There have always been people in the hospitals doing this work, but the leadership is increasingly seeing the value in this and is looking for a system-wide strategy where they are sharing best practices within the larger health care system.”



As a leading membership and networking group for hospitals interested in eco-friendly practices, Practice Greenhealth is working hard to bring together hospitals with similar goals so they can benefit from others’ experiences.

To that end, two sets of invaluable data just came out with the release of the third and final Milestone Report and the sixth annual Sustainability Benchmark Report.

While the two reports encompass some of the same measures, each is distinctive. The 2014 Milestone Report, based on Healthier Hospitals Initiative enrollees, is a snapshot of some 900 hospitals—not all Practice Greenhealth members—tracking progress in six “Challenge” areas for which data was submitted. They are: Engaged Leadership, Healthier Food, Leaner Energy, Less Waste, Safer Chemicals and Smarter Purchasing.

“This year is the culmination of our three-year Healthier Hospitals Initiative and we have had over double the number of data submissions,” Howard said. “We’ve learned that it really takes time for people to understand the data set and translate that into leadership involvement.”

The Healthier Hospitals Initiative launched in April 2012 with the backing of a dozen of the largest U.S. health systems to create a guide for reducing energy use and waste and purchasing safer products and healthier food.

“Healthier Hospitals enrollees are now spending more than $68 million on healthy drinks. And our work has only just begun.” — Sherry MacDonald, Director of Marketing and Communications at Practice Greenhealth

Sherry MacDonald, director of marketing and communications at Practice Greenhealth, calls out a few successes revealed in the final Milestone Report. “Collectively, Healthier Hospitals enrollees have reduced health care greenhouse gas emissions by 73,600 metric tons—the equivalent of removing 15,600 vehicles from U.S. roads each year. Together, we’ve recycled 445,722.39 tons of materials from hospitals across the country, which is 45,000 garbage trucks by weight. We’ve scaled back sugar-sweetened beverages and are now spending more than $68 million—nearly 70 percent of our beverage budget—on healthy drinks. And our work has only just begun.”

Another trend the reports highlight is employee engagement and understanding, Howard said. “When you are offering healthier choices for meals at the hospital cafeteria, like reduced sugar beverages or getting rid of the fryer; showing that healthy options can still be very satisfying; offering things like walking trails, stress reduction programs and incentivizing people to have a healthier behavior, these are ways to engage employees.”

Going forward, the initiative will fold into Practice Greenhealth as a free program called Healthier Hospitals for those health systems just getting started on the journey toward sustainability and will continue to capture aggregate data and report back to hospitals, Howard said.


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However, for those hospitals that want a much more detailed look at their eco-friendly progress, membership in Practice Greenhealth is the best choice. The Sustainability Benchmark Report, available only to Practice Greenhealth members, highlights data from member hospitals that applied for and won Practice Greenhealth’s Environmental Excellence Awards. The report is the nation’s most comprehensive set of data and analysis of leading indicators for health care sustainability performance.

“I explain it like this: HHI is like a self-service buffet where you can pick and choose what you want to try,” Howard said. “Practice Greenhealth is like table service, offering you much more support and service individualized for you as a member.”

Cecilia DeLoach Lynn, director of sector performance and recognition at Practice Greenhealth, agreed. “The Benchmark Report goes much deeper into sustainability and tells you what components are driving the metrics and how you can get there,” she said.

Any member organization that completes the Partner for Change application receives a Metrics Report Card that demonstrates the individual facility’s performance on 19 of the metrics measured within the award application, DeLoach Lynn said, as well as access to the full Benchmark Report with aggregate data from all award-winning hospitals.

The 2014 Benchmark Report shows that Practice Greenhealth award winners saved more than $111 million through sustain-ability activities. They also prevented 102,000 tons of waste from going to the landfill and saved $28 million by recycling in 2013.

Highlights from the report also showed:

  • In 2013, a median of $99,941 was saved from sustainable programs implemented in the operating room, with the highest performers seeing a savings of $641,788 yearly.
  • Some 88 percent of facilities have implemented reprocessing programs, saving a total of $49.2 million and diverting 847 tons of waste out of the regulated medical waste stream.
  • Eighty percent of award-winning hospitals are now recycling clinical/medical plastics in the OR.
  • Hospitals saved more than $25 million through energy reduction and more than 275 million gallons of water and $12 million through conservation in 2013.

Climate change is another priority. While many hospitals are just starting to address climate change as a threat to public health, the Benchmark Report showed that 21.5 percent of award winners had performed a greenhouse gas emissions audit. And, the report revealed, hospitals are increasingly addressing many of the contributors to climate change and are making concerted efforts to decrease energy use, create programs that divert waste from landfills through recycling and source reduction, and save on food miles by buying local and reducing meat use.

Hospitals are also willing to put their money where it can make the most difference. Eighty-eight percent of award-winning hospitals had appointed or hired someone to lead sustainability work in 2013, DeLoach Lynn said. Eighty-three percent of award winners reported purchasing third-party certified green cleaning chemicals, she said. And when it comes to “green building”—still thought of as the more expensive option—more hospitals are understanding that the return on investment is high in energy and waste dollars saved.



As both reports show, hospitals are exhibiting an increased awareness and willingness to undertake change in order to make a healthy difference for tomorrow. A good example is University Hospitals, a $3.5 billion health system in northeast Ohio and Practice Greenhealth member. The health system has 15 hospitals including Case Medical Center, 29 outpatient health centers and primary care physician offices in 15 counties.

Realizing that some medical and nonmedical furnishings could contain harmful chemicals such as halogenated flame retardants and formaldehyde, University Hospitals’ major medical centers committed to HHI’s Safer Chemicals Challenge.

The effort took a two-pronged approach of clear communication internally to employee purchasers and externally to suppliers about the environmental, health and cost-saving benefits of using HHI-compliant products.

“Asking vendors to share whether or not their products contain HHI chemicals of concern was typically a novel ‘ask’ that required legwork on the hospital side,” said Matthew Pietro, sustainability specialist for University Hospitals.

The health system collaborated with suppliers to develop an innovative “healthy furniture catalog” of purchase standards to simplify the purchasing process for UH employees.

To date, University Hospitals reports spending more than $760,000 on furnishings free of HHI chemicals of concern, which represents 71 percent of total spend from reporting vendors. Along the way, hospital leadership gained a clearer understanding of how and where to reduce exposure of patients and employees to known chemicals of concern that they hope to share industry-wide.

“Through our purchasing and operating practices, we believe we can help promote the development of safer chemicals and more sustainable materials for use in health care and beyond, fostering a healthier environment for all,” said Dr. Aparna Bole, manager of sustainability at University Hospitals and pediatrician at UH Rainbow Babies & Children’s Hospital.


Carolyn Kimmel is a freelance journalist based in Pennsylvania. She has more than 25 years’ experience writing for newspapers and magazines.