Climate Action Strategies at Kaiser Permanente Joe Bialowitz, Environmental Stewardship Project Manager August 26, 2009 Copyright Kaiser Permanente 2009

Outline

Presentation goals:

• Why Kaiser Permanente and other health care organizations have global warming concerns • Understand health care’s climate footprint • Review Kaiser Permanente’s climate action plan • What have we done?

• What are we working on?

• How does this tie in to your work?

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Kaiser Permanente’s Evolving Role as a Total Health Organization

Do Good Things Ensure access to high quality care and coverage Make an Impact Address the conditions of health in the physical, social, natural environment Be Accountable for All Our Impacts Understand our ecological and economic footprint, and their impact on community health; act accordingly; set a good example Page 3

Kaiser Permanente’s Environmental Stewardship Council Our Environmental Stewardship Council has identified the following four environmental focus areas to guide our work: Climate Action Safe Chemicals Sustainable Food Waste Reduction

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Organizational Guideline on Climate Action

Kaiser Permanente will:

•

Understand climate change

• Assess climate-related impacts • Commit to continuous improvement  Take practical actions to limit emissions of carbon dioxide and other greenhouse gases  Help reduce the carbon footprint of the communities we serve by supporting: a) appropriate land-use and transportation decisions b) development of appropriate local food systems •

Support industry standards

•

Inform public policy

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Effects of Climate Change

Climate change is causing health effects that potentially impact Kaiser Permanente’s ability to fulfill our promise of quality, affordable health care

• Global climate instability increases the demand for health care • Cost of energy and water likely to continue increasing while supplies diminish • Threats to forests and biodiversity threaten availability of potential cures for diseases Page 6

Health Effects of Climate Change

A few examples:

• ↑ Temperature + ↑ UV radiation + primary

emissions = ↑secondary air pollutants (ground-level ozone, particulates)

• ↑ extreme heat episodes = ↑ electric power

use = ↑ emissions & pollutant formation

• ↑ Temperatures + ↑ CO2 = ↑ Ragweed in urban

locations = ↑ risk of asthma & allergy

• ↑ Biomass + more arid conditions = ↑ risk of

wildfires = ↑ risk of injury & ↑ air pollution

Source: CA Department of Public Health Page 7

Kaiser Permanente’s Greenhouse Gas Inventory

Direct Greenhouse Gas Emissions in 2007 by Kaiser Permanente

Fleet vehicles 1.6% Medical gases (estimated) 9% Natural gas 23% Emergency power generation 0.2% Purchased electricity 66% Page 8

Kaiser Permanente’s Greenhouse Gas Emissions Trend

New construction and increased energy use associated with electronic medical records are two key reasons why our combined CO2 emissions from use of electricity and natural gas grew by more than 10% between 2005 and 2007: 400000 350000 300000 250000 200000 150000 100000 50000 0 Electricity Gas 2005 2006 2007 Year

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Kaiser Permanente’s Greenhouse Gas Emissions Trend

Energy efficiency initiatives for building systems and electronic equipment have helped to decrease our emissions intensity per square foot since 2006: National average for all hospitals = >30 lbs/sqft Source: DOE (2003 CBECS)

40.00

35.00

30.00

25.00

20.00

15.00

10.00

5.00

33.66

36.40

35.10

2005 22.90

2006

Year

24.88

2007 24.58

lbsC02/"AboveTheLine"sqft lbsC02/gross sqft “Above The Line” sqft = Medical Services, Hospital Services, Outpatient Pharmacy, Optical, Other Benefits, & Health Plan Admin “Below the Line” sqft = Regional Admin, Property Management, Program Offices, Parking, & Vacant/Under Construction Page 10

Energy-based Climate Action Strategy

350000 300000 250000 200000 150000 100000

Harvard University’s campus GHG reduction plan New Construction

Assumes 15% growth

Green New Construction

Assumes 15% growth & 50% less GHG intensity per square foot

Energy Conservation

- Building Upgrades and Retrofits - Occupant Education - Green Construction & Renovation - Controls Upgrades

Generation Efficiency

- Cogeneration - Steam & Chilled Water Efficiency - Fuel Mix - Electric Utility Selection

Renewable Energy Generation

On or off site solar, wind, biomass, geothermal Page 11 50000 0 2008 2009 2010 2011 2012 2013 2014 2015 Source: Harvard University 2016 2017 2018 2019 2020

Carbon Offsets -

Reforestation - Renewable Energy Purchases - White Tags

Broad-based Climate Action Strategy

Breakdown of NHS England 2004 Emissions

Travel 18% Procurement (not including pharmaceuticals) 39% Building energy use 22% Pharmaceuticals 21%

Source: NHS England Carbon Emissions: http://www.sdu.nhs.uk/page.php?page_id=93 Page 12

Broad-based Climate Action Strategy

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Organization-wide Risk Assessment To Determine the Most Significant Contributors to Global Warming

Excerpt from risk assessment Page 14

Goals Based on Risk Assessment and Overall Priorities of the Organization Kaiser Permanente is linking its Sustainable Energy Strategy with its Climate Action Plan to pursue GHG emissions reductions through organization-wide activities in the areas of:

• • • • • • • • Benchmarking Building systems Efficient delivery of care and service Plug loads Food Transportation Waste reduction Employee engagement Page 15

Benchmarking and Building Systems: ENERGY STAR Performance Ratings Building-specific, campus-specific, region-level, and system-wide benchmarking, goal-setting, dashboarding and best-practice sharing

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Site Characteristics 100 75 50 25 0 Apply for ENERGY STAR label, and share best practices Operational change Retrofit Candidate Confirm data and set immediate goal of improving rating by 10 points within 1 year

Benchmarking: Conserving Energy by Conserving Water KP Hospitals vs. Other's Water Benchmark Comparison

Water efficiency comparison for hospitals, 2008

Average Annual Gallons per Bed

200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0

107,143 182,699 135,222 KAISER PERMANENTE OTHER U.S. HOSPITALS OTHER CALIFORNIA HOSPITALS

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Benchmarking

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Major accomplishments as of August 2009:

• • •

Goals

Greenhouse gas inventory (Climate Registry) Energy audits Water use (40% below average U.S. hospital) Measure and report: • Eco-Health Footprint (Global Health and Safety Initiative’s new calculator tool to help measure and manage carbon emissions, resource intensity, and toxic pollutants) • Energy performance ratings for existing and new buildings • Waste volumes

Building Systems: Energy-conserving Building Standards

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Building Systems: Energy-conserving Building Standards – Major Accomplishments Between 1994 and 2009:

• Installed 100 acres of cool roofs • • • • Lighting occupancy sensors (10% decrease in lighting energy use) Light fixtures (30% more energy efficient than average) Building automation controls systems maximized energy efficiency Adopted an energy efficient HVAC (heating, ventilation, air conditioning) design standard • Installed co-generation plants in 7 hospitals (~45% decrease in energy to heat water and ROI of ~20%) •

Goals:

• Windowpanes with low emissivity glass (50% to 70% reduction in solar heat) Adjust design templates to achieve ENERGY STAR rating of 75 or greater for each hospital and medical office building planned for construction.

• Establish targets for improving the energy performance (in BTUs/sqft) of existing building portfolio • By 2011 reduce the combined annual water use of the hospitals, medical office buildings and commercial office buildings by 5% Page 20

Building Systems: Sustainable Energy Scorecard for Kaiser Permanente’s Regions Energy Program Element

Sustainable Energy Sponsor Web-based / Enterprise enabled Utility Billing System Energy Star Benchmarking GHG Tracking Audits Demand Management Retrocommissioning Renewable / Sustainable PPA Commodity Procurement ●

NCAL SCAL NW HI CO OH GA MAS

● ● ● ● ● ● ● ● ● ● ● ◒ ◒ ◒ ◒ ◒ ◒ ◒ ◒ ◒ ● ● ◒ ◒ ● ○ ○ ◒ ◒ ◒ ◒ ◒ ◒ ◒ ○ ● ● ● ○ ◒ TBD ● ● ● ◒ ◒ ◒ ◒ ◒ ◒ ◒ ◒ ◒ ◒ ◒ ◒ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ● ● ● ◒ ◒ In Place ◒ In Progress ○ Not Started

Key Energy Program Elements are already in place or underway in several regions

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Building Systems: Onsite Renewable Energy Generation Major accomplishments as of August 2009:

• Solar photovoltaic array at Modesto Medical Center Page 22

Goals:

• Install 5 megawatts of new onsite solar energy generation this year

Building Systems: Onsite Renewable Energy Generation Major drivers:

• Reduce Kaiser Permanente’s impact on global warming • • • • • • • Element of National Energy Strategy Hedge against future regulation Lower long-term energy costs Eliminate risk of electrical cost fluctuations Diversify supply Brand benefits Retain Renewable Energy Credits Page 23

Onsite Renewable Energy Generation

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Building Systems: Roof-mounted Solar Array

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Building Systems: Solar Field

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Building Systems: Solar Carports

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Efficient Care and Service Delivery

Major accomplishments as of August 2009:

• Electronic medical records • In-house distribution networks for specimen, supplies and equipment • In-house and mail-order pharmacies • Email-your-doctor

Goals:

• Evaluate technologies for recycling anesthetic gases and establish targets for reducing emissions of waste anesthetic gases • Engage members to take advantage of efficient delivery models such as mail order prescriptions, email-your-doctor and mobile clinics Page 28

Plug Loads

Major accomplishments as of August 2009:

• Electronic Product Environmental Assessment Tool (EPEAT) Silver rating for all newly deployed laptop and desktop computers in 2008 • Timers and occupancy sensors for vending machines in California

Goals:

• • • • EPEAT Gold-rating for all newly deployed laptops and desktops in 2009 Determine percentage of ENERGY STAR labeled printers and set target for increasing this percentage Determine the most energy-intensive medical equipment and set target for improving energy efficiency In 2010 all equipment and appliances provided by builders of new California Kaiser Permanente hospitals have to be ENERGY STAR labeled if ENERGY STAR is applicable to that equipment or appliance Page 29

Reducing Carbon Footprint by Reducing Waste

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Waste Reduction

Major accomplishments as of August 2009:

• Patient meal preference software reduces waste • Single-use device reprocessing reduced waste by ~208,198 pounds, avoided ~$90,000 of waste disposal costs and saved ~$5.7 million in medical device costs • Resold or rendered into raw materials and recycled 74,000 pieces of Kaiser Permanente’s electronic equipment • Recycled 100% of building materials generated from demolition of warehouses at construction site of new hospital • Standardized service process for document destruction improved diversion of paper waste to recycling stream

Goals:

• Sustain and, where possible, expand existing programs Page 31

Food

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Food: The Impact of Agriculture Policy on the Environment

• The Gulf Dead Zone • Corn and soybean

monocrops

• Extensive use of

fertilizers and pesticides

• Soil erosion • Concentrated Animal

Feeding Operations

• Groundwater contamination • Air quality • Antibiotics for livestock Source: Lustig, 2008 Page 33

Food

Major accomplishments as of August 2009:

• Hosting 30 farmers markets and farm stands in 4 states • Locally grown produce is part of inpatient meals at 23 of our hospitals • Ad campaign and partnerships with community groups to promote healthy eating

Goals:

• • Increase percentage of our overall food spend allocated to foods that are more sustainable than conventional alternatives Support development of local food systems featuring locally grown, sustainably farmed food Page 34

Transportation

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Impact of Car Culture on the Environment

California’s Greenhouse Gas Emissions by Sector 2004

(Gross emissions: 433.3 MMT CO2e) Page 36 Air Resources Board. Greenhouse Gas Inventory. http://www.arb.ca.gov/cc/inventory/data/graph/graph.htm

Transportation

Major accomplishments as of August 2009:

• Ad campaign and partnerships with community groups to promote active living and building parks and bike paths • Successfully encouraged our largest materials distributor to join the EPA Smartway program • Rightsizing initiative for our courier vehicles (conserved 20,786 gallons of gasoline and saved $79,610) • Videoconferencing (avoided ~5,000 metric tons of C02 emissions in 2008 and saved ~$2.5 million)

Goals:

• • Sustain and expand accomplishments above Reduce business travel by 25% in 2009 Page 37

Employee Engagement

http://insidekp.kp.org/insidekp/reduceyouruse/index.htm

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Employee Engagement

Major accomplishments as of August 2009:

• Reduce Your Use campaign encourages Kaiser Permanente physicians and employees to reduce consumption of resources • In 2008, staff eliminated the use of 240,000 sheets of paper and 20,000 disposable bags

Goals:

• • First half of 2009 campaign: “Get Tapped In” to reduce bottled water use Second half of 2009 campaign: “Lights Out on Global Warming” to conserve energy Page 39

Lessons Learned: Benchmarking

An annual GHG inventory is a crucial first step toward measuring and managing emissions. An automated utility bill payment system facilitates tracking of energy use and GHG emissions.

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Lesson Learned: Work With Others to Build a Social Movement GHSI is a coalition of health care systems and organizations working to sector wide movement working together to transform the way hospitals build, buy and operate their facilities

• Open source sharing of information and best practices • Group purchasing to transform the market • Research to document benefits, improvements, outcomes http://www.globalhealthsafety.org/ Page 41

• • • • • •

Moving Forward: Key partners for success

• • Direct Energy: KP-IT, NFS, P&S, Green Teams Supply chain: P&S, Green Teams Food: P&S, Nutrition Services, Green Teams Transportation: Commuter programs, HR, KP-IT, Green Teams Pharmaceutical manufacturing: Pharmacy

Adaptation of care and service delivery to mitigate global warming and adapt to its health effects:

Medical groups, DOR, UCDA, Green Teams Industry standards: GHSI, Climate Registry Public policy: Industry associations and health advocacy groups Page 42

Resources

For additional information about environmental stewardship at Kaiser Permanente, please visit our Green Resource Center: www.kp.org/green Or visit our Green Teams web site: http://kpnet.kp.org/ehs/green_team/index.htm

Or contact: Joe Bialowitz, Environmental Stewardship Project Manager [email protected]

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