Order Out of Chaos

By Janet Brown, Director, Facility Engagement, Practice Greenhealth and Director, Content and Outreach, Healthier Hospitals Initiative on September 25, 2013

How to prevent waste and create recycling opportunities.

When I walk into my 15-year-old daughter’s bedroom, I am overwhelmed by the clothing, trash, and other debris littering seemingly every flat surface. Usually I exit quickly, shut the door, and tell myself, “not my problem.” But periodically, usually when she is away at camp, I spend several hours attempting to create order out of chaos and help her to have a fresh start. I bring with me a recycling bag, a “give away” box, and a trash bag in order to sort through her things, decide what to donate, discard, and recycle, and otherwise clean up the room.

Screen Shot 2013-09-23 at 4.47.53 PMTransfer my overwhelmed feeling to the individual responsible for the “back door” of a health care facility today. Hospitals generate, on average, over 30 pounds of waste per bed, per day, based on the Practice Greenhealth Sustainability Benchmark Report. Unlike in a teenager’s room, however, we can’t turn around, shut the door, and say, “not my problem.” But in some ways, a hospital does just that when it simply pays the bill without taking a closer look at waste prevention and recycling opportunities. In so doing it wastes valuable resources, both material and financial.

In the course of providing health care day after day, hospitals amass a wide range of leftovers, from food to electronics, including disposable food service ware, gloves, packaging, IV bags, tubing and other devices, office paper, batteries, pharmaceuticals, hazardous chemicals, pallets, pillows, laboratory waste, ceiling tiles, broken furniture, and many other disposable materials designed for “safe” health care delivery. Not only are the materials voluminous, but they also vary in material composition and thus in their opportunities for prevention, reuse, and recycling.

The Healthier Hospitals Initiative’s (HHI)Less Waste Challenge is an antidote to the chaos—it provides some basic guidance and win-win opportunities for gathering baseline data, reducing red bags, increasing recycling and recycling/diverting construction and demolition debris from construction and renovation projects. The goals of the challenge were designed to achieve good results right from the start, and to begin taking control of this continuous flow of material.

Defining Materials and Streams

The power of HHI is data—the key to the kingdom is standardization and definitions. In the case of a waste and material baseline, this indicates a need to categorize and measure materials and wastes in a standardized fashion and to use a standard normalizer to compare with others in the sector. One of the many benefits of HHI is access to guidance on standardization and measurement of materials and wastes—a must-do for any sustainability team.

The document “Defining Materials and Streams,” is one of several free resources available to HHI enrollees. It helps them establish a baseline and understand the various slices of the waste/material pie. Normalizers include percentage of total and total waste, or type of waste, per adjusted patient day. Total waste allows for capture of waste prevention successes. Other helpful documents include a recycling checklist, a red bag standardization form, and more. All of these documents are available on the HHI website, in the resources section of the Less Waste Challenge.

Diversion versus Recycling

The baseline tracking measures recycling but not prevention or diversion rates. At Practice Greenhealth, we encourage prevention, the success of which can be measured in total waste per adjusted patient day. We count composting as a form of recycling. While a hospital may want to measure diversion activity and its impact, tracking diversion can be tricky. Commonly diverted items include reusable pallets and reusable dishware. Food donations, equipment donations and even single-use device reprocessing also fall into the diversion category. Reusable sharps containers will be reflected in the Regulated Medical Waste (RMW) rate and do not count toward recycling. Success rates in these areas will be reflected in measures of total waste or, for single-use devices, in red bag rates.

Although some single-use devices and the reusable containers themselves are eventually recycled, they are not counted in recycling rates in the Practice Greenhealth Awards program. It’s hard to ascertain the frequency of this recycling and its impact on individual sites. A vendor may report that 90 percent of single-use devices are recycled, but that doesn’t mean that 90 percent of what a hospital reprocesses is recycled. The same is true for sharps. A container may be reused 600 times before it is recycled; however, calculating that number for each customer is nearly impossible.

A Step-by-Step Approach

To complement the How-To Guidance Documents found on the HHI website, last June, the Healthier Hospitals Initiative held a series of sharing calls for each goal of each HHI Challenge. Access the archived calls to understand the goals of the baseline requirement and the three goals of the Less Waste Challenge, or any goal in the initiative. The Less Waste calls review the data collection and submission requirements for each of the goal areas. The power of HHI is strength in numbers. The more enrollees that submit their data, the clearer the message—hospitals are demonstrating the environmental and financial benefits of improving environmental performance. Any hospital—large, small, urban, rural—can benefit from the win-win strategies developed by the Healthier Hospitals Initiative.

Quick Reference

  • HHI Less Waste How-To Guide
  • Defining Materials and Streams
  • Less Waste Data How-To Series

All of these are free and can be found on the HHI website at www.healthierhospitals.org. Only enrolled facilities can access these free resources. Questions? jbrown@healthierhospitals.org.

Steps to Success

  1. Identify the Team
  2. Engage Leadership
  3. Understand Waste Streams
  4. Gather the Data
  5. Recycling Versus Diversions
  6. Set up a System
  7. Track Material
  8. Analyze the Data and Set Measurable Goals
  9. Track, Report, and Continue to Monitor
  10. Celebrate Success and Identify next Priority Prevention or Recycling Opportunity