The Magic of Metrics

Managing assets and making smart choices are hallmarks of a successful sustainable initiative. Metrics bring the details into focus.

By Kathy F. Mahdoubi on July 28, 2016

bar graph made of grass

Instituting Healthier Hospitals greening programs across a large network of health care facilities is laudable in its own right. Ensuring their long-term success and expansion is another matter entirely. If health systems and their constituent centers want to stay the course, the use of solid metrics to track and measure the progress of their environmental commitments is crucial.

Some hospital networks choose to install custom greening software that creates a systemwide dashboard to visualize and mold enormous volumes of in-house and third-party data. Still others prefer a system of reporting that utilizes manually entered vendor data to track sustainability outcomes. Greenhealth connected with greening leaders from two exemplary health systems, University Hospitals Health System headquartered in Cleveland, and Bon Secours Health System headquartered in Marriottsville, Maryland, to find out what metrics the institutions use to reach their environmental goals.

Striking the Right Balance

University Hospitals is a large network of medical centers across Northeast Ohio including a 1,032-bed tertiary center by the same name affiliated with Case Western Reserve University in Cleveland. The main campus is home to a National Cancer Institute designated Cancer Care Center, the University Hospitals Seidman Cancer Center, as well as both dedicated women’s and children’s hospitals. UH Health System also includes more than 10 community hospitals and a variety of other practices. The progressive network of health care centers made the bold choice to roll out a number of sustainability programs.

“In the early stages of our sustainability journey we developed a set of priority areas to begin coordinating our strategy and goals,” said Matthew Pietro, UH sustainability specialist. “Targeted outcomes in these priority areas provide positive social, economic and environmental impacts that also contribute positively to public health in some way.”

UH Health System bolstered these efforts by making a commitment to the national Healthier Hospitals Initiative. Pietro noted that the best way for a health system to begin is by recognizing “low-hanging fruit,” such as streamlining waste and implementing recycling programs, which inspire and engender initial support, and then teaming up to look at energy efficiency between health centers and tamping down the use of harmful chemicals in cleaning protocols. It also pays to watch for specific interest at the executive level, so sustainability programs can “strike while the iron is hot” and enterprise new greening projects.

Metrics From the Cloud

To measure its success, UH Health System has installed a cloud-based sustainability dashboard by Key Green Solutions in Grand Rapids, Michigan. The software allows internal users to access data and trigger reports for special projects using data gathered from the hospital network’s major suppliers. Vendor data is compiled and submitted via electronic data interchange to populate UH Health System’s specialized dashboard.

“We started using it in earnest in 2012, working with the Key Green team to customize reports based on our priority areas,” said Pietro. “We worked with the vendors and Key Green to set up the parameters of the data reported by the vendors. In some cases, the reports need to be manually updated into the dashboard, which is completed by Key Green data specialists adding no work to our internal team.”

Outside of PGH Metrics University Hospital

University Hospitals Health System uses the Key Green Solutions dashboard to track sustainability progress.

This process frees up the hospital network’s stakeholders from manually entering data and allows for the thoughtful evaluation of monthly, quarterly and annual reports. Push reports on set sustainability outcomes go directly from the dashboard to users’ email inboxes in easy-to-read PDF files.

Using this dashboard, UH Health System has established a number of metrics. In terms of minimizing waste, it measures networkwide recycling rates by weight and total waste profile; construction and demolition debris by weight; and money-saving landfill diversion strategies that include refurbishing devices and reformulating surgical kits to cut down on items that typically go unused. The hospital network also actively donates items whenever possible.

UH Health System currently maintains a mercury-free status and cuts down on harmful emissions. The hospital network is eradicating medical products that contain PVC and DEHP and tracks dollars spent on Green Seal-certified cleaning products for all floors, windows and bathrooms. Dollars spent on flame-retardant, antimicrobial, PVC perfluorinated compound and formaldehyde-free furniture are tracked as well.

To measure energy efficiency, UH Health System monitors energy use intensity throughout its hospitals with the aid of the EPA’s online ENERGY STAR Portfolio Manager. For environmentally sound purchasing, the network uses the Electronic Product Environmental Assistance Tool (see the Sustainability Spotlight on page 26 for more on EPEAT) to select electronics and follows the U.S. Green Building Council’s Leadership in Energy and Environmental Design rating system for other select purchases. Additionally, UH sources local services for new construction and comprehensive renovations.

Green nutrition is a big priority. UH Health System tracks dollars spent on Healthier Hospital-qualified labels and other third-party certified sustainably produced foods. Local sourcing is defined as food sourced within 250 miles. UH also tracks amounts spent on beef with the intent to reduce network provisions of red meat and has set goals to measure the nutrient content of desserts and snacks and to track the use of healthy beverages as an alternative to sugary drinks.

Qualitative Measurements

For those things that cannot be measured in electronic reports, such as personal commitment and hospital morale, there are outreach and training programs. For the most part, participation in the UH Health System’s sustainability program is not compulsory from a hierarchical standpoint, but it is fostered at every level, and that goes a long way in recruiting support from hospital personnel. Certain priorities, however, such as energy programming and local sourcing, are the rule.

“The Greening UH program is actively, truly supported by system leadership, which carries a lot of weight,” said Pietro. “Much of the time the outcomes we are tracking make a lot of business sense in addition to having social and environmental health benefits.”

Once all the data is collected for the year, an annual progress report is sent to UH Health System leadership. They, in turn, get involved with sustainability councils and related committees. The health network has taken it a step further by creating a points program at the faculty level called Healthy UH points, which can be earned through carpooling and other sustainable transportation and events that provide healthy food options. At the end of the year, the entire network participates in a sustainability celebration.

The Metrics of Good Health

The Bon Secours Health System, headquartered in Marriottsville, Maryland, is a sweeping network of 19 acute-care hospitals, a psychiatric hospital and various nursing and assisted living facilities. Initially, the Bon Secours Green Program was modeled after Practice Greenhealth resources and the successes of other Catholic health systems. Like UH, the greening precedent began with the network’s waste management efforts.

“Waste management was chosen as the initial foundational activity for employee green engagement due to the compelling recycling benefits that each individual could personally contribute to and the tangible opportunity to enhance the health status of communities we serve by reducing hazardous red bag waste in landfills,” said David McCombs, vice president of supply chain operations for Bon Secours. “This area also had a very strong operating cost return on investment for the greening changes, so it was well supported by operations executives as a cost-reduction initiative.”
Bon Secours also utilizes networkwide metrics, but opts for a different system of its own design based on established business operations and grassroots processes, including invoice review. The Bon Secours Board Performance Dashboard requires no outside consultation or analytics model. Vendor data is gathered at the supply chain central office and is used to populate the dashboard. Reports are distributed to all levels of operation, and the health system office communicates with individual markets within the network on a monthly basis to review performance and outline action plans for areas that need improvement and to acknowledge successes as they occur.

Since committing to waste reduction, Bon Secours has established systemwide vendor contracts for invoice processing and data collection, waste management reporting that measures 30 different waste streams and key organization indicators for recycling, as well as regulated medical waste, as a percentage of total waste per pound.

Energy efficiency was another major priority that took time to roll out. Bon Secours first established a baseline and organizational model in the first year before endeavoring to reduce energy use in subsequent years. Like UH, Bon Secours currently uses ENERGY STAR tools, and the main metric for energy use intensity is the Site Energy Utilization Index, which is calculated in thousands of British thermal units (kBTU) per square foot per year. The hospital network has already established tracking for greenhouse gas emissions, which is measured as the metric tons of carbon dioxide equivalent per year. Bon Secours maintains sustainable purchasing of products and services by using environmentally preferred purchasing tools that measure vendor spending within discrete product categories. They reserve special focus on limiting toxic materials in purchased products. When it comes to nutrition, Bon Secours tracks the percentage of healthy provisions out of total food and gathers data about locally sourced foods.

Unlike UH, the Green Program at Bon Secours is mandated. This goes for all acute-care hospitals, ambulatory centers and individual skilled nursing facilities. Metrics for achieving a high level of sustainability are evaluated annually at the local and regional levels and are revisited monthly on an ongoing basis.

Looking Ahead

Both UH and Bon Secours have a strong set of metrics already in play, but continuing to build momentum is key. This year is the UH Health System Year of Sustainable Transportation. UH is seeking to work with local, regional and national transportation networks to gain a better understanding of different modes of transportation that can be leveraged for health care use. UH also wants to get a handle on emissions from hospital fleet operations and hospital worker commutes and track the positive impact of sustainable transportation programs. Additionally, UH Health System is setting sights on defining a networkwide energy management program with a timeline of measurable goals. Key performance indicators such as energy intensity use and total cost, as well as greenhouse gas emissions profiling would be tracked under the revamped program, with return-on-investment and payback period assessments carried out for projects as they roll out.

Metrics for achieving a high level of sustainability are evaluated annually at the local and regional levels and are revisited monthly on an ongoing basis.

Bon Secours has recently established a new water utilization metric based on ENERGY STAR resources to develop a baseline of gallons per square foot per year. This information will be used to plan the next three years of water conservation efforts including designs on recycled and potable water use.

These two hospital networks use different metrics models applied across an impressive array of health care environments with great success. Using these measurements, both UH and Bon Secours manage to set and achieve their sustainability goals while meeting and exceeding the highest standards of patient care.

Bon Secours has implemented systemwide metrics tracking to manage its sustainability initiatives.

Bon Secours has implemented systemwide metrics tracking to manage its sustainability initiatives.